Does industry-sponsored education foster overdiagnosis and overtreatment of depression, osteoporosis and over-active bladder syndrome? An Australian cohort study

ObjectivesTo investigate patterns of industry-sponsored educational events that focus on specific health conditions for which there are concerns about overdiagnosis and overtreatment.Design and settingThis retrospective cohort study examines publicly reported industry-sponsored events in Australia from October 2011 to September 2015 for three conditions potentially subject to overdiagnosis and overtreatment: depression, osteoporosis and overactive bladder. We used a database of transparency reports to identify events with a focus on depression, osteoporosis and overactive bladder and compared these with other sponsored events. We hypothesised that companies marketing treatments for each condition would sponsor related events and that target audiences would mainly work in primary care, reflecting a broad patient population.Main outcome measuresEvent and attendee characteristics, sponsoring companies, related marketed treatments, cost-effectiveness ratings and dispensing rates.ResultsOver the study period, we identified 1567 events focusing on depression, 1375 on osteoporosis and 190 on overactive bladder (total n=3132, with 96 660 attendees). These events were attended by primary care doctors more often than sponsored events without a focus on these three conditions: relative risk (RR)=3.06 (95% CI 2.81 to 3.32) for depression, RR=1.48 (95% CI 1.41 to 1.55) for osteoporosis and RR=2.59 (95% CI 2.09 to 3.21) for overactive bladder. Servier, which markets agomelatine and AstraZeneca (quetiapine) sponsored 51.2% and 23.0% of depression events, respectively. Amgen and GlaxoSmithKline, which co-market denosumab, sponsored 49.5% of osteoporosis events and Astellas and Commonwealth Serum Laboratories (CSL) (mirabegron and solifenacin) sponsored 80.5% of overactive bladder events.ConclusionsThis 4-year overview of industry-sponsored events on three overdiagnosed and overtreated conditions found that primary care clinicians were often targeted, dinner was often provided and that a few companies sponsored most events. In most cases, sponsors’ products are not cost-effective choices for the specified condition. This pattern highlights the need for professional education to be free of commercial sponsorship.</jats:sec

A cross-sectional analysis of pharmaceutical industry-funded events for health professionals in Australia

Objectives: To analyse patterns and characteristics of pharmaceutical industry sponsorship of events for Australian health professionals and to understand the implications of recent changes in transparency provisions that no longer require reporting of payments for food and beverages. Design: Cross-sectional analysis. Participants and setting: 301 publicly available company transparency reports downloaded from the website of Medicines Australia, the pharmaceutical industry trade association, covering the period from October 2011 to September 2015. Results: Forty-two companies sponsored 116 845 events for health professionals, on average 608 per week with 30 attendees per event. Events typically included a broad range of health professionals: 82.0% included medical doctors, including specialists and primary care doctors, and 38.3% trainees. Oncology, surgery and endocrinology were the most frequent clinical areas of focus. Most events (64.2%) were held in a clinical setting. The median cost per event was $A263 (IQR$A153–1195) and over 90% included food and beverages. Conclusions: Over this 4-year period, industry-sponsored events were widespread and pharmaceutical companies maintained a high frequency of contact with health professionals. Most events were held in clinical settings, suggesting a pervasive commercial presence in everyday clinical practice. Food and beverages, known to be associated with changes to prescribing practice, were almost always provided. New Australian transparency provisions explicitly exclude meals from the reporting requirements; thus, a large proportion of potentially influential payments from pharmaceutical companies to health professionals will disappear from public view

Correlations between the selection of topics by news media and scientific journals

The aim of this study is to reveal a robust correlation between the amount of attention international journalism devotes to scientific papers and the amount of attention scientific journals devote to the respective topics. Using a Mainstream-Media-Score (MSM) ≥ 100 (which we regard as an indicator for news media attention) from the altmetrics provider Altmetric, we link 983 research articles with 185,166 thematically similar articles from the PubMed database (which we use to operationalize attention from scientific journals). The method we use is to test whether there is a concomitant increase in scientific attention after a research article has received popular media coverage. To do so, we compare the quotient of the number of thematically similar articles published in scientific journals during the period before and after the publication of an MSM ≥ 100 article. Our main result shows that in 59 percent of cases, more thematically similar articles were published in scientific journals after a scientific paper received noteworthy news media coverage than before (p < 0.01). In this context, we neither found significant differences between various types of scientific journal (p = 0.3) nor between scientific papers that were originally published in renowned opinion-leading journals or in less renowned, non-opinion-leading journals (p = 0.1). Our findings indicate a robust correlation between the choice of topics in the mass media and in research. However, our study cannot clarify whether this correlation occurs because researchers and/or scientific journals are oriented towards public relevance (publicity effect) or whether the correlation is due to the parallelism of relevance attributions in quality journalism and research (earmark hypothesis). We infer that topics of social relevance are (more) likely to be picked up by popular media as well as by scientific journals. Altogether, our study contributes new empirical findings to the relationship between topic selection in journalism and in research

Lessons about Boundaries and Reciprocity in Rural-based Preceptorships

This paper is a report of a photovoice study of rural nursing preceptorship experiences in Western Canada. Background: Rural preceptorship placements are a vital means of recruiting new nurses to rural settings. Contextual knowledge is essential for students undertaking such preceptorships, as well as for educators, and researchers. It is widely known that rural nurses and their clients share a culture of self-reliance, adaptability and flexible professional boundaries, but the role of preceptors in conveying this culture to students warrants deeper exploration. Methods: Four nursing students and their four rural preceptors (nurse educators) took part in an eighteen month photovoice study, facilitated by the researchers, between 2009 and 2010. Coding of the data and collaborative thematic analysis with the participants yielded a number of conceptual categories, which formed the basis of a photographic narrative of rural nursing preceptorship. Findings: Nursing students learn to manage the competing scripts of policy and community ethos during rural preceptorships. Rural nurses track between professional and personal roles both on and off the job. Familiarity with clients as neighbours, friends and family can lend added personal significance to caregiving, but it can also lead to stress and role dissonance. As community members, rural nurses take part in a tacit economy of reciprocal giving. Conclusion: Rural nurse preceptors teach students that flexible boundaries and reciprocity are aspects of a community code underpinning rural clinical practice. This code, and the social capital it represents, should be factored into nursing curricula as an essential component of rural community wellness. _ Résumé Le présent article rapporte les résultats d’une étude Photovoice sur des expériences de préceptorat en sciences infirmières en région rurale dans l\u27Ouest canadien. Contexte : Les stages avec un précepteur en milieu rural constituent une méthode primordiale de recrutement de nouvelles infirmières dans les milieux ruraux. Une connaissance du contexte s\u27avère essentielle pour les étudiantes qui entreprennent de telles expériences comme préceptées, ainsi que pour les formateurs et les chercheurs. Il est bien connu que les infirmières en milieu rural et leurs clients partagent une culture d\u27autonomie, d\u27adaptabilité et de souplesse quant aux limites professionnelles, mais le rôle des précepteurs dans la transmission de cette culture aux étudiantes nécessite une étude plus approfondie. Méthodes : Quatre étudiantes en sciences infirmières et leurs quatre précepteurs ruraux (formateurs en sciences infirmières) ont pris part à une étude Photovoice de dix-huit mois, menée par les chercheurs, entre 2009 et 2010. Le codage des données et l\u27analyse thématique collaborative avec les participantes ont permis de générer des catégories conceptuelles qui constituent la base du récit photographique du préceptorat en sciences infirmières en région rurale. Résultats : Les étudiantes en sciences infirmières apprennent à gérer des situations conflictuelles d\u27éthos politique et communautaire pendant les stages en région rurale. Les infirmières en régions rurales jouent un rôle tantôt professionnel, tantôt personnel, qu\u27elles soient au travail ou non. La familiarité avec les clients qui sont des voisins, des amis et des membres de la famille peut ajouter une signification personnelle accrue aux soins, mais peut aussi entraîner un stress et une dissonance de rôles. En tant que membres de la collectivité, les infirmières en région rurale prennent part à une économie implicite d\u27aide mutuelle. Conclusion : Les précepteurs en sciences infirmières dans les régions rurales enseignent aux étudiantes que des limites souples et la réciprocité sont des aspects du code communautaire qui sous-tend la pratique clinique en milieu rural. Ce code, et le capital social qu\u27il représente, doit être pris en compte dans le programme de sciences infirmières en tant qu\u27élément essentiel du bien-être des collectivités rurales

‘A Most Equitable Drug’: How the Clinical Studies of Convalescent Plasma as a Treatment for SARS-CoV-2 Might Usefully Inform Post-Pandemic Public Sector Approaches to Drug Development

Interventional clinical studies of convalescent plasma to treat COVID-19 were predominantly funded and led by public sector actors, including blood services operators. We aimed to analyze the processes of clinical studies of convalescent plasma to understand alternatives to pharmaceutical industry biopharmaceutical research and development, particularly where public sector actors play a dominant role. We conducted a qualitative, critical case study of purposively sampled prominent and impactful clinical studies of convalescent plasma during 2020-2021. We found that studies were mobilized and scaled at record pace due to well-connected investigators who engaged in widespread sharing of clinical trials resources, regulatory facilitators, and public funding and infrastructure. Clinical studies also served to build public sector and health system capacity and generate clinical trials and blood services infrastructure. Though convalescent plasma represents a failed COVID-19 treatment, key insights from these studies can be used to enhance the likelihood of success of future models of biopharmaceutical production, designed in the service of ensuring equitable access to biopharmaceuticals, should the political will and financing to support such models someday follow

Decoding disclosure: comparing conflict of interest policy among the United States, France, and Australia

&quot;Sunshine&quot; policy, aimed at making financial ties between health professionals and industry publicly transparent, has recently gone global. Given that transparency is not the sole means of managing conflict of interest, and is unlikely to be effective on its own, it is important to understand why disclosure has emerged as a predominant public policy solution, and what the effects of this focus on transparency might be. We used Carol Bacchi\u27s problem-questioning approach to policy analysis to compare the Sunshine policies in three different jurisdictions, the United States, France and Australia. We found that transparency had emerged as a solution to several different problems including misuse of tax dollars, patient safety and public trust. Despite these differences in the origins of disclosure policies, all were underpinned by the questionable assumption that informed consumers could address conflicts of interest. We conclude that, while transparency reports have provided an unprecedented opportunity to understand the reach of industry within healthcare, policymakers should build upon these insights and begin to develop policy solutions that address systemic commercial influence

The “Hot Potato” of Mental Health App Regulation: A Critical Case Study of the Australian Policy Arena

Background: Health apps are a booming, yet under-regulated market, with potential consumer harms in privacy and health safety. Regulation of the health app market tends to be siloed, with no single sector holding comprehensive oversight. We sought to explore this phenomenon by critically analysing how the problem of health app regulation is being presented and addressed in the policy arena. Methods: We conducted a critical, qualitative case study of regulation of the Australian mental health app market. We purposively sampled influential policies from government, industry and non-profit organisations that provided oversight of app development, distribution or selection for use. We used Bacchi’s critical, theoretical approach to policy analysis, analysing policy solutions in relation to the ways the underlying problem was presented and discussed. We analysed the ways that policies characterised key stakeholder groups and the rationale policy authors provided for various mechanisms of health app oversight. Results: We identified and analysed 29 policies from Australia and beyond, spanning 5 sectors: medical device, privacy, advertising, finance, and digital content. Policy authors predominantly framed the problem as potential loss of commercial reputations and profits, rather than consumer protection. Policy solutions assigned main responsibility for app oversight to the public, with a heavy onus on consumers to select safe and high-quality apps. Commercial actors, including powerful app distributors and commercial third parties were rarely subjects of policy initiatives, despite having considerable power to affect app user outcomes.Conclusion: A stronger regulatory focus on app distributors and commercial partners may improve consumer privacy and safety. Policy-makers in different sectors should work together to develop an overarching regulatory framework for health apps, with a focus on consumer protection

“It’s Not Smooth Sailing”: Bridging the Gap Between Methods and Content Expertise in Public Health Guideline Development

Background: The development of reliable, high quality health-related guidelines depends on explicit and transparent processes, methods aimed at minimising risks of bias and the inclusion of all relevant expertise and perspectives. While the methodological aspects of guidelines have been a focus to improve their quality, less is known about the social processes involved, for example, how guideline group members interact and communicate with one another, and how the evidence is considered in informing recommendations. With this in in mind, we aimed to empirically examine the perspectives and experiences of the key participants involved in developing public health guidelines for the Australian National Health and Medical Research Council (NHMRC). Design: This study was conducted using constructivist grounded theory as described by Charmaz, which informed our sampling, data collection, coding and analysis of interviews with key participants involved in developing public health guidelines.Setting: Australian public health guidelines commissioned by the NHMRC.Participants: Twenty experts that were involved in Australian NHMRC public health guideline development, including working committee members with content topic expertise (n = 16) and members of evidence review groups responsible for evaluating the evidence (n = 4).Results: Public health guideline development in Australia is a divided process. The division is driven by 3 related factors: the divergent disciplinary background and expertise that each group brings to the process; the methodological limitations of the framework, inherited from clinical medicine, that is used to assess the evidence; and barriers to communication between content experts and evidence reviewers around respective roles and methodological limitations.Conclusion: Our findings suggest several improvements for a more functional and unified guideline development process: greater education of the working committee on the methodological process employed to evaluate evidence, improved communication on the role of the evidence review groups and better facilitation of the process so that the evidence review groups feel their contribution is valued